Comforting those near the journey's end

“Comfort” is a balm we embrace as warmly as we do a forgiving lover. It can be a fire on a January night. It can be ice cream on an August afternoon. More lastingly, it can be the nearness of someone dear.

Or to our legion of the infirm and afflicted, comfort can mean that pain and suffering are held at bay from the mind and body. To achieve that, hospitals today emphasize pain management. In the case of those with serious or terminal illnesses, palliative-care teams act to serve “body, mind and spirit.”

A member of that care team at Scripps Memorial Hospital Encinitas is chaplain Bill Harman.

Harman is a 74-year-old former pastor in Encinitas who retired from his church and now sits at the bedside of patients who would rather be any place else. His job is to listen, reassure when possible, counsel and be a go-between for patient and others, if necessary. Though a Lutheran, his aim is to be scrupulously respectful of all faiths.

Nothing is more important to him than to remind people of what is often left behind at the admitting desk — hope.

So, Bill, what hope is there for a patient with no hope of living?

“If we’re religious, we might have hope for afterlife. If we’re an atheist, we might have no hope for an afterlife, but have hope for no pain, no suffering.”

Patient stress can be increased by the very medical advances that strengthen their hope, because the hospital is where advanced care happens. Since the hospital is by its nature an impersonal institution, the intimacy of being at home with the family is absent. Harman recalls his grandmother dying at 72 in the late 1950s.

“She was in my aunt’s home in bed, surrounded by family. The doctor had said there was nothing else that could be done. There were no attempts to extend her life. The most she got were ice chips to keep her mouth moist. She died peacefully.”

He says being religious, even fervently, is no guarantee of peace of mind for the terminally ill. For one thing, a sense of guilt for past sins might create angst about what lies beyond. On the other hand, an atheist might be reconciled that the end is the end and have little worry.

“One of my patients, a scientist, said he was an atheist when I introduced myself. I said, ‘Well, this is your lucky day. I’m also the chaplain for the atheists.’ He did not fear death because he believed it was a natural process. He had no concept of heaven or hell, so he escaped all that.”

Harman tries to accommodate the beliefs of all faiths by arranging visits by clergy or by reaching out himself.

“One patient of the Sikh faith was nonresponsive until she heard the words of a traditional Sikh chant, “wahe guru,” repeated in her ear by me. Her eyes opened and she smiled as she repeated it with me. Hindus appreciate the sound of chimes and bells as part of their meditation, as do many Buddhists.

“(Christians) often respond to hearing the words of the Lord’s Prayer or the 23rd Psalm. I have been with patients in their final phase of dying who will open their eyes and repeat the words with me.”

Have you encountered a patient who has been a nonbeliever and suddenly wants to become a believer?

“Never. Never.”

So there are no atheist-converts in the fox hole?

“Not in my fox hole, not so far.”

How about grief or guilt about a life badly lived?

“There’s some of that. One man was very concerned that he had not been loving toward his family. I suggested his family come so they could talk about it, and he agreed.

“His family was very reassuring and told the man they had felt his love, though he hadn’t always expressed it, but they sensed it. So there was a nice reconciling moment.”

Were you left wondering if they just said that because that’s what they were supposed to say?

“It does make you wonder.”

Harman tells of a woman with end-stage cancer who wanted reconciliation with her daughter who had been estranged for 20 years. The daughter was called and came to visit, and reconciliation was achieved. Harman talked to both afterward.

“The daughter was a bit bewildered as to why her mother waited all that time to reach out. (The daughter) hadn’t reached out, either. Of course, the mother was equally bewildered about why the daughter hadn’t reached out. That’s what happens in families.”

Why is that, if both want to reconcile?

“Pride or fear, or both.”

Harman says regret over things done or not done tends to fade with the age of the patient: The older we become, the more we’re willing to let the past remain in the past.

Those who deny their mortality are more common, Harman says of patients who refuse to acknowledge approaching death.

“We had a man about 55 who had been in the hospital with end-of-life cancer. He refused to accept that he was dying, always seeking some kind of cure. Even when his wife would tell him it wasn’t going to work, he would not accept it, all the way to the very end. He was Catholic and he would not allow a priest to be called for anointing. He always said to me, as a chaplain, ‘No, no, no, not yet. I’m not there yet. I’m not there yet.’ Well, he was there.”

Palliative care takes many forms. Harman tells of an ardent surfer who was terminal. He wanted to spend one last night near the ocean. The hospital arranged an ambulance and medical attendants to take him to a quiet place on the beach. Afterward, he was taken home, where he died the next day.

We’ve all heard of someone who pushed back death through the “will to live.” Harman, though, is vague about it and sounds unconvinced, at least in the miraculous way we’re sometimes told. He believes the “will” is mainly beneficial if it motivates us to seek treatment that improves quality of life. But ultimately, he says, “the reality is, if your body has a disease, it’s going to end.”

You refer to “body, mind and spirit.” Can you define spirit?

“Spirit is the essence of us that’s indefinable.”

You just did a good job of not defining it.

“I know. It’s a mystery. It’s a mystery. We use the catch-all term ‘God’ to describe that which we don’t understand or don’t know or can’t fathom.”

Harman says he has never seen the miraculous faith healing that many believe in, but believes it can happen. He’s heard other chaplains tell of “spontaneous remissions.”

Are you a believer in the white light?

“Yes, because as a person dies, there are medical explanations for it. Basically, things are changing in terms of the connections in your brain, and the white light is a very common part of the end of life.”

So it isn’t necessarily indicative of an afterlife?

“It could be, if that’s been your teaching, your background. It can be very significant.”

It can mean what you want it to mean?

“Exactly, like most things. We put the meaning into things, don’t we?”

Harman takes issue with the popular characterizations of the dying process.

“In the popular culture, there are images about death and dying that are not realistic. (On television) 90 percent of patients (who) have cardiac resuscitation come back to life and live. The reality is, it’s less than 20 percent, so that gives us a certain image. The dying scenes, where the person is speaking their last words, closing their eyes and dying, that’s very rare, because the body doesn’t do it that way. It takes time. It’s a process.”

Do most people go out in peace?

“I think so, because drugs available to us these days can make it a comfortable situation. The least bit of morphine can calm the breathing and the anxiety, and can lead to a very peaceful passing.”

I was thinking of guilt, of anger, of regrets.

“Having stress and anxiety within, the process itself will not be as smooth as if you have an accepting spirit of relaxation, a giving in. That’s why it’s helpful when families, for example, will tell the person who’s dying, ‘It’s all right to go.’ Because a lot of us try to hold on for our families.”

Harman is a believer in hospice care, especially home hospice, which can replicate the gentle passing of his grandmother back in her daughter’s home in the ’50s. Countering that, he says, “If you totally go the aggressive care route, regardless of medical advice, you will be in the (intensive care unit) at the end of your life.”

The end time is not for change, but for acceptance. And chaplain Harman is there to quietly remind that peace within matters when the world no longer does.

Fred Dickey’s home page is freddickey.net. He believes every life is an adventure and welcomes your thoughts and ideas at freddickey@roadrunner.com.